This inspection was carried out on 9th May 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
CARE HOMES FOR OLDER PEOPLE
Scarborough House Clubbs Lane Wells Next The Sea Norfolk NR23 1DP Lead Inspector
Ann Catterick Unannounced 09 May 2005 12.15pm The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Scarborough House Address Clubbs Lane Wells Next Sea Norfolk NR23 1DP 01328 710309 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Imperial Care Homes Limited Ms Lisa Reed Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 07 February 2005 Brief Description of the Service: Scarborough House is a care home providing personal care and accommodation for 17 older people. There were 15 service users accommodated on the day of inspection. The home is owned by Imperial Care Homes and the registered manager is Lisa Reed. The home is located in the coastal town of Wells and is located close to shops, public transport and other local amenities. The home is a two storey detached property with a single extension attached to the side of the original building. The home offers bedroom accommodation on the ground and first floor. The home has a variety of communal areas throughout the home. A new kitchen has recently been installed. There are patio and garden areas that are accessible to service users and these are well tended with attractive potting and planting. Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on the 9th of May, over a period of four hours and was unannounced. The purpose of the inspection was to follow up a complaint received by the CSCI concerning inappropriate manual handling techniques. The inspector was able to speak to Steve Smith, provider, Lisa Reed, registered manager, staff and service users. Documents and care plans were inspected. The main focus of this inspection was centred on issues relating to manual handling, however, the inspector had the opportunity to look at some other standards and outcomes. What the service does well: What has improved since the last inspection?
The window in the bedroom that did not have a window restrictor has now had one fitted. It has been arranged for Boots the Chemist to come to the home in June and offer Boots foundation training to all care staff on the administration of medication. Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 None of these standards were inspected. EVIDENCE: Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 A service users needs were seen to be set out in a care plan but the instructions relating to manual handling were not being followed. Manual handling care needs are not being fully met for all service users. EVIDENCE: One care plan was looked at and the area focussed on was the mobility needs of the service user. This part of the care plan had been completed in 2003 and although it had been reviewed on a regular basis there was little detail in the reviews. The care plan instructed that this service user should be assisted with her mobility by the use of a hoist but this was not happening and the manager was aware that this was not happening. The promotion of mobility and moving and handling issues are at the forefront of the health care of service users. Manual handling assessments need to be carried out and these then need to be followed. It appeared that for some service users manual handling assessments were completed but there was not regular monitoring to ensure that the agreed practice was being followed at all times.
Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 Not all service users felt that the routines of daily living were meeting their preferences and they felt some of the routines of daily living were limited. Most service users were satisfied with the quality of the food however some were concerned about the practice of being served both breakfast and lunch in their bedrooms. EVIDENCE: Some service users suggested that there were not many social activities within the home. It was suggested that staff spent their time with the practical tasks around care and had little opportunity to spend social time with service users. The manager had said that she had booked the mini bus a few weeks previously but had had to cancel due to other commitments. The company has a mini bus that is shared by the three homes but Scarborough House had not used this since September 2004. Most of the comments received about food were positive. There was no fruit in the home on the day of inspection and it was suggested that fruit should always be available to service users. Some service users said that they were encouraged to eat their tea in their bedrooms and this meant that they lost the opportunity for making tea-time a social occasion and it also meant that
Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 11 service users often remained in their bedrooms until the following day. If service users have a preference to remain in their room this is fine but there should be opportunity for socialisation and activity as well. Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 None of these standards were inspected. EVIDENCE: Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 26 Those service users who had specific manual handling needs had not had these needs assessed by a suitably qualified person, such as an occupational therapist. The Home does not have all of the specialist equipment required to maximise service users independence. The home was clean and tidy on the day of inspection and free from any offensive odours. EVIDENCE: The home has some moving and handling equipment and one manual hoist with different slings. The manager had tried to secure the services of an occupational therapist to offer advice with regard the moving and handling of a particular service user but had not been successful. This matter needs to be followed up with the appropriate authorities. Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 14 All service users spoke positively about the environment and the home was clean and tidy on the day of inspection. Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and30 It was not clear as to whether the amount of care staff and kitchen staff on duty at any one time was meeting the needs of all the service users. None of the care staff have a formal social care qualification and this needs to be addressed to ensure that the care in the home is provided by competent qualified staff. Evidence showed that staff had received training in the area of manual handling and that the knowledge and skills gained were not always being used in practice. Other areas of training were not inspected. EVIDENCE: The kitchen staff, within the home, work from 9.30am until 1.30pm with care staff being responsible for the preparation of breakfast and tea. These meals are usually taken in the service users bedrooms. For staff to prepare and service meals this means that there are times when only one carer is available to be with service users. It has been recommended that the staffing of the home during the day be assessed to ensure that the service users needs are being met. Staff receive induction and foundation training but no staff have completed NVQ level 2 and this needs to be encouraged to ensure some staff have a formal social care qualification. It was disappointing to find that no staff had these qualifications.
Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 16 All staff receive manual handling training but staff and management acknowledged that some service users were being moved in ways that were not appropriate and could put both service user and staff at risk. An example given was of assisting a service user into the standing position by using the underarm system. Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 There has recently been some lack of communication between manager and provider and this was highlighted within this inspection. With regard manual handling practice the health and safety of welfare users has not always been promoted and protected. EVIDENCE: A requirement had been made about manual handling at the last inspection.The inspection report identifying this had not been seen by the proprietor. Staff had received training in manual handling but their skills and knowledge in this area has not been monitored on a regular basis and some poor practice has been allowed to develop. Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION x x x 1 x x x 3 STAFFING Standard No Score 27 2 28 1 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x x x x x x 2 Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 22 Regulation 13.5 Requirement The registered provider must ensure that service users with mobility needs are assessed by a suitably professional. The registered provider must ensure that arrangements are made for the safe manual handling of service users and that any appropriate equipment needed is made avaliable The registered provider must ensure that staff are trained to use any equipment provide for service users to ensure that they can be moved safely. The registered provider must ensure that the home aims to have a least 50 of staff trained to NVQ level 2 or its equivalent. Timescale for action 01/07/0 2. 22 13.5 01/06/05 3. 22 13.5 01/06/05 4. 28 18.c 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 12 Good Practice Recommendations It would be good practice for the registered provider to promote more activities within the home during the day
I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 20 Scarborough House 2. 27 3. 15 4. 38 and evening to offer recreational stimulation to service users. It would be good practice for the registered provider to reassess the number of care staff and kitchen staff provided in the home to ensure all of the needs of service users can be met with the number of staff provided. On the day of inspection there was no fruit in the kitchen or store cupboard and the inspector would see it as good practice to ensure that fruit is available to service users on a regular basis. It would be good practice to consider having the tiled hallway carpeted to minimise the risk of injury if a service user fell in this area. Scarborough House I55 s27502 Scarborough House v226191 (un) 090505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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